If you've had a stroke, preventing a second stroke is a top priority. "The risk of a stroke is tenfold higher in someone who has had a stroke in the past," says Larry B. Goldstein, MD, professor of medicine (neurology) and director of the Duke Stroke Center in Durham, N.C.
Prevention of a second stroke starts by addressing conditions that caused the first stroke, such as atrial fibrillation (an abnormal heart rhythm that can cause blood to clot) or narrowing of a carotid artery in the neck. Treatment is also aimed at other factors that put you at risk, including high blood pressure, diabetes, and high cholesterol. But it takes more than just your doctor's efforts. You also have an important role to play in preventing stroke. It's up to you to make lifestyle changes that can lower your risk.
A stroke can be a devastating experience. Surviving it can be a powerful motivation to make lasting positive changes in your life. Take charge of your future by following these recommendations.
Prescription for Recurrent Stroke Prevention
Antiplatelet drugs and anticoagulants are medicines that can help reduce the risk of a second ischemic stroke. These medicines interfere with the blood's clotting action so that clots can't form and cause a stroke. Aspirin is one of the most common, most effective, and least expensive types of antiplatelet medication.
There are several types of blood thinners available, and your doctor will choose one based on your medical history, your health conditions, and the potential for side effects. For example, people with a bleeding disorder may not be able to take aspirin.
When you use these medications, it's important to take them as prescribed. Even if you've taken aspirin in the past for pain relief, do not take more than your doctor recommends. Also, ask about potential interactions. For instance, the most commonly used anticoagulant, warfarin, can be affected by other drugs and by foods, such as green leafy vegetables, which are high in vitamin K.
Know Your Numbers: Keep Blood Pressure Low
High blood pressure exerts continuous pressure on the walls of the arteries. If it is left untreated, it damages and weakens your arteries, making them more likely to clog or burst and cause a stroke. Hypertension is the biggest contributing risk factor to stroke.
Making lifestyle changes that reduce your stroke risk will also help you manage your blood pressure. You will also need to take blood pressure medicine every day. Be sure to talk with your doctor if you notice any side effects. But don't stop taking medication unless directed to do so.
Ask your doctor what your target blood pressure should be. Using a home blood pressure monitor can help you track your pressure and know if your medication is working.
Don't Give Up -- You Can Quit Smoking
Quitting cigarette smoking is an important step you can take to reduce your risk of a second stroke. And the benefits come quickly -- just five years after you stop smoking, your risk for stroke will be the same as that of a nonsmoker. Cigarette smoking is one of the biggest contributing risk factors to stroke.
"There's no question that quitting smoking is extraordinarily difficult," Goldstein says. But if you've tried to quit before and failed, don't despair. According to a Gallup poll, former smokers needed an average of six attempts before they stopped smoking for good. So the more you try, the better your chance of succeeding.
Talk with your doctor about which smoking cessation method is right for you. The best programs provide counseling and nicotine replacement therapy (NRT) or medication. Studies show that just by using anti-smoking medication or NRT, you can double your chance of success.
Make a plan to avoid people who smoke, and if you live with a smoker, ask them to take it outside. Not only will being around other smokers tempt you to light up, but all their puffing is bad for your health. "Secondhand smoke is probably as important a risk factor for stroke as being the primary smoker," Goldstein tells WebMD.
Revamp Your Diet
Improving your diet will address a number of risk factors for stroke -- including being overweight. "Start by replacing high-fat foods with low-fat and lean versions, and replace refined and high-sugar foods with whole grains, fruits, and vegetables,” says Julia Renee Zumpano, RD, LD, a registered dietitian in preventive cardiology and rehabilitation at the Cleveland Clinic. “These changes will provide you cardio-protective antioxidants and boost the fiber in your diet. Boosting the fiber can help you feel fuller and more satisfied. As an added bonus, certain types of fiber can also help lower your cholesterol.”
Although there are many approaches to eating healthy, following these basic guidelines can help simplify the process:
- Stock up on fresh or frozen fruits and vegetables. Buy produce in an array of colors -- reds, oranges, yellows and greens -- to get a range of nutrients.
- Buy only whole-grain bread, cereal, rice, and pasta.
- Choose poultry, fish, and lean meats.
- Add nuts, seeds, and legumes (beans and peas) to your meals several times a week.
- Buy only fat-free or low-fat dairy products.
- Use healthy fats such as olive, canola, and other vegetable oils or plant-based stanols, and look for trans-free margarines.
- Toss your salt shaker. Don't add salt while cooking or at the table.
- Read food labels and avoid foods high in sugar, sodium, saturated fat, and trans fat.
- Try to have at least one meatless meal a week. Eating more of a plant-based diet makes it easier to limit cholesterol and unhealthy fats.
When your cupboard is bare, it can be all too easy to resort to fast food. "That's why it's so important to have healthy foods available at all times," Zumpano says. She suggests stocking up on convenience items such as low-fat and low-sodium frozen dinners, fruit such as apples and oranges that won't spoil quickly, and granola bars and trail mix so that you always have healthy meal and snack options on hand.
You can boost your weight loss efforts by eating breakfast every day, keeping portions small, drinking plenty of water or other calorie-free drinks, and learning how to make healthy choices when eating out.
Make Your Move
When it comes to the benefits of exercise, there is really no downside to moving your body. However, because you've had a stroke, you should talk with your doctor before starting an exercise program. Once you get the OK, these tips can help you get moving.
- If you have disabilities from your stroke, work with your doctor or physical therapist to tailor an exercise program that works for you.
- For most people, taking a 20 to 30 minute walk every day is ideal. If that length of time is too much for you right now, break it up into two or three 10-minute chunks throughout the day.
- Gradually build up to at least 30 minutes of moderate-intensity exercise on most days. Moderate-intensity level activities include brisk walking, gardening, water aerobics, and wheeling yourself around if you are in a wheel chair.
Moderation in All Things -- Especially Alcohol
Heavy alcohol use -- more than one to two drinks a day -- increases the risk of stroke by 69% in people who haven't had a stroke. Excessive drink can also increase your blood pressure.
Moderate alcohol use -- defined as two drinks a day for men and one drink a day for women -- may actually help protect against stroke. Any more than that may put your health at risk. However, if you don't drink, there is no reason to start.
If you need to cut back, avoid having alcohol in the house, try not to drink every day, and learn to savor alcohol -- not gulp it. If you feel like you can't control your drinking, talk with your doctor about how to stop.
Make Stroke Prevention a Family Affair
"A stroke affects everyone in the family, not just the person who had the stroke," Goldstein says. "Make a plan as a family to eat healthier, get more exercise, and clear the air of cigarette smoke. By working together, you'll find it easier to stick with new habits."